Devyn Brown IND 339WI Article Summaries (22) Article 1 Citation Rabig, J., Thomas, W., Kane, R., Cutler, L. & McAlilly, S. (2006). Radical redesign of nursing homes: Applying the Green House concept in Tupelo, Mississippi. Gerontological Society of America, 46(4), 533-539. Study Design Study of providing independence, through self-containing houses, to residents in assisted living facilities and how it affects them, family members, and employees of the facilities Results Summary The results of the Green House method proved that adding some levels of independence and a more residential feel in an assisted living facility helped the residents to feel at-home and more able, compared to what is seen in a typical assisted living facility. Overall, residents were more engaged in the activities in their private residence (like cooking) and social activities. Some residents even began using their wheelchairs less, as they were able to travel through their space with much more ease and less worry, due to the smaller living space and a more present staff. Setting Mississippi Methodist Senior Services (MMSS) Sample Population Older adults Site Questions/Design Implications What differences in design would have to be incorporated for individuals with dementia or Alzheimer’s? Those who are not capable of caring for themselves/may pose a threat to themselves or others?
Article 2 Citation Zeisel, J. (2013). Improving person-centered care through effective design. American Society on Aging, 3(37), 45-52. Study Design Focus on independence in an assisted living facility, managed through exit control, walking paths, common spaces, privacy and personalization, garden access, residential feel, sensory comprehension, support for capacity, and how to support enrichment of lives through these aspects. Results Summary Individuals who are allowed to express their independence become more confident in themselves and their abilities. This begins to show outwardly, through presentation of abilities to others, causing others to treat them with more respect and dignity than if they were not as confident in themselves. The respect and dignity shown by others encourages the residents further, resulting in a cycle of independence and ability, and respect from others. Allowing a resident to have privacy of and personalize their living space provides them a sense of ownership over their environment, creating more levels of comfort and normalcy. Setting Assisted Living Facilities (in general) Sample Population Older adults – those with disabilities (physical and/or cognitive), specifically dementia Site Questions/Design Implications To what level should independence be granted to people with disabilities? What happens if they injure/hurt themselves because they were given too much independence where they could not handle it? How do older adults with less abilities view others with more abilities? “Unfair” treatment, feeling “managed” or “babysat”? When residents are used to that level of independence, does it become a danger to themselves/others as their abilities decrease with age?
Article 3 Citation Sampsell, B.G. (2003). The promise, the practice, and problems of the Eden Alternative. Nursing Homes Long Term Care Management, 6, 42-44. Study Design Incorporating the Eden Alternative (philosophy relating to how life is about continuing to grow, even as we age and/or experience challenges and disabilities) into a long-term facility in order to give residents a sense of purpose, peace, and independence, improving their day-to-day lives. Results Summary In an ideal situation, the Eden Alternative should have worked well in the LTC facility; its benefits seemed to outweigh the costs, and its goal was to provide its residents with a sense of peace and independence, and a higher day-to-day quality of life. However, the results did not necessarily match those expectations. Staff responsibilities were increased, including training and educating others, and this was not necessarily communicated well throughout the process. Complications that weren’t considered came into view, such as the addition of animals, who may not be well-trained enough to interact with older adults. Even so, there were considerable successes; residents were participating in new activities, such as interacting with the children and animals, watering plants, etc., and they even began taking care of themselves more often, proving that the EA helps with encouraging independence among LTC facilities’ residents. Setting Long-term care facility – Eden Alternative (EA) Sample Population Long-term care facility residents and employees Site Questions/Design Implications If a resident does not want to participate in the watering of plants or interacting with animals, what sort of activities are available for them to do? And how does this put stress on employees who have to then multitask for the entirety of their shifts (overseeing more than one activity with multiple residents attending)? Are there enough spaces to accommodate large, social gatherings and smaller, quiet gatherings at the same time? Or do residents who do not want to participate in the larger activities have to wait in their private bedrooms in the meantime?
Article 4 Citation Brownie, S. (2011). A culture of change in aged care: The Eden Alternative. Australian Journal of Advanced Nursing, 29(1), 63-69. Study Design Using the Eden Alternative in order to combat the plagues of aging – loneliness, helplessness, and boredom – in RACFs. The EA aims to promote autonomy, selfdetermination, and emotional and social wellbeing, something that not all assisted living facilities can feasibly grant to their residents. Results Summary Implicating the Eden Alternative showed improvements in many areas, such as a reduced staff turnover percentage, fewer complaints by residents, faculty, and family members, fewer incidents/falls, as well as a reduction in the need for medication or restraints. Additionally, there were significant improvements seen in the emotional and social wellbeing of the residents, relating to feelings of loneliness, helplessness, and boredom. Because the EA allowed residents to have more autonomy and decisionmaking power in their day-to-day lives and activities, residents feel more independent and confident in their abilities, resulting in less feelings of helplessness. Additionally, encouraging more social interactions among residents plays a big role in their feelings of loneliness and boredom. Setting Western Australia respite centers Sample Population Individuals working and living in residential aged care facilities Site Questions/Design Implications Staff turnover, in some areas, actually increased, as compared to the control groups. What are the differences between the facilities where staff turnover increased and facilities where it decreased? How can these differences be amended in order to reduce the staff turnover percentage, as seen in some of the RACFs utilizing the EA model?
Article 5 Citation Eijkelenboom, A., Verbeek, H., Felix, E., & Hoof, J. (2017, April 20). Architectural factors influencing the sense of home in nursing homes: An operationalization for practice. Retrieved February 14, 2021, from https://www.sciencedirect.com/science/article/pii/S2095263517300079#s0010 Study Design Providing a personalized and home-like residence for older adults in assisted living facilities may have a positive impact on the adjustment period as they move into their new environments, as well as the long-term stay afterward. Results Summary In order to create a home-like residence for older adults in assisted living facilities, the architecture and interior design of the facility must be considered; it cannot be solely based on the items a resident is allowed to bring in with them. Contrary to popular belief, in order to create a home-like residence, the size of the living spaces should not be scaled down. Yes, it is common to associate smaller rooms with a sense of coziness. However, in order for residents to interact with each other and host family members, the size of the rooms must accommodate for multiple people at a time. Feeling overcrowded in a space is not home-like, and therefore should be avoided. Additionally, the amount of privacy that is granted to older adults in ALFs has a lot to do with the home-like feel of their environment. Being able to close their bedroom doors and not worry about someone coming in, uninvited, is very important, as well as having a private restroom that they can use at any time without worrying about someone else using it. Setting Assisted living facilities, assisted living facilities for people with dementia Sample Population Older adults in assisted living facilities Site Questions/Design Implications How can these sorts of design philosophies be incorporated into ALF buildings that already exist? How much redesign would be necessary in order to create this home-like environment that more and more facilities are trying to attain?
Article 6 Citation F. Carr, R. (2017, July 04). Nursing home. Retrieved February 14, 2021, from https://www.wbdg.org/building-types/health-care-facilities/nursing-home Study Design The way that nursing homes are set up and laid out have an immense impact on the day-to-day lives of the residents who live there and the employees who work there. The design of the nursing home must take into consideration physical and cognitive disabilities that the residents may have, but also to provide them with levels of comfort, through a safe, homelike, clean, and therapeutic environment. Results Summary When considering the layout of a nursing home, public access and private bedrooms/bathrooms must be accessible by wheelchair. Additionally, grab bars must be provided so that residents are less likely to fall and injure themselves or others. Nonreflective and slip-resistant flooring will also play a part in minimizing falls. However, the care aspect of a nursing home is not the only thing to consider when designing the environment; it must also foster a sense of home for the individuals living there, rather than a hospital-like, institutional feel that many nursing homes feature. Large, spacious gathering places allow for leisurely activities and social interactions between residents, family members, guests, and employees. Maximizing the amount of natural light that enters the facility will not only help regulate circadian rhythms, which is incredibly important as individuals begin spending more of their time indoors, but also to reduce the amount of artificial light being used within the facility, helping with energy use and costs. Finally, wayfinding and signage must be clear and direct. Using easy-to-read fonts with high contrast between the background and text will allow residents, even those with visual impairments, to read them and find their way around the facility. Also, choosing to not label doors not intended for resident access will help steer their interest away from those areas. Setting Nursing homes Sample Population Residents of ALFs – nursing homes Site Questions/Design Implications As for sunlight exposure – how can designers create a way to view the outdoors without creating a sense of longing/feeling trapped indoors?